Service Request

Repair Xpress makes service and repairs EASY!

Simply call our toll free number (1-877-581-3733), or complete the Service Request Form below and we do the rest.

  • Step 1: We will Identify insurance eligibility if applicable.
  • Step 2: We will in some cases, come to your home and immediately repair your equipment on-site. If special parts are in need of replacement, we will offer you a loaner to use while your equipment is being serviced at our facility.
  • Step 3: Repair Xpress technicians assess the parts needed to repair your equipment.
  • Step 4: Repair Xpress comes to your home with your repaired equipment that looks and works like a champ!

Service Request Form

For your convenience, each of the following sections can be displayed or hidden by clicking the section title.

Provider Information

Patient Information

Insurance Information

Product Information

Prescribing Physician Information

Wheelchair & Scooter Manufacturers

Repair Xpress is proud to service virtually all the leading manufacturers in the industry. If you don’t see your wheelchair or scooter brand listed below, please contact us directly – odds are we can still repair your wheelchair or scooter!